Along with two recent BSN graduates-Brandon R. Nye and Christina E. Hyde, Dr. Anne Alexandrov co-authored a recently published article in Critical Care Evaluation (November, 2012) entitled “Slim stroke scales for assessing patients with acute stroke: Ease of use or loss of valuable assessment data?”. The NIH Stroke Scale (NIHSS) has been the standard instrument for neurologic assessment of ischemic stroke since 1996. However, nurses are sometimes uncomfortable administering the NIHSS due to its length (15 items) and to the complexity of some items (e.g. extraocular movements, visual fields, ataxia and extinction). Several shortened or “slim” versions of the NIHSS that delete items from the full assessment have thus been developed and are being used by nurses for neurologic evaluation of stroke patients. This article reports on a retrospective study comparing scores on the full NIHSS, three “slim” versions of the NIHSS and the Glasgow Coma Scale (GCS) in patients with either ischemic or hemorrhagic stroke.

Dr. Alexandrov and her colleagues performed a retrospective analysis on a convenience sample of 172 stroke patients over a four month period. All subjects had recorded scores for both the full NIHSS and the GCS recorded in their charts. For each subject, the authors determined what their score would have been on the three “slim” versions of the NIHSS by subtracting the items deleted from that scale. Analysis of these scores revealed that each of the slim versions would have classified a significant number of stroke patients as having no deficits when they did, in fact, have potentially disabling neurological impairment. The Glasgow Coma Score performed even more poorly than the slim scales, misclassifying 56% of patients as having no neurological deficits when disability was detectable on the NIHSS. As patients without neurologic impairment are often not treated with tissue plasminogen activators, it is crucial to avoid false negative assessments.

The authors conclude that it is important for nurses to adhere to the full version of the NIHSS. This instrument is valid and reliable, allows for consistency between physicians and nurses, and is more likely to detect signs of potentially disabling neurologic impairment. It is possible that over time or at some intervals during intra-arterial reperfusions, customized NIHSS items focusing on patients’ specific deficits may be acceptable.